iPet’s Ally Weekly Q&A Round-up 02-01-21: What is ileocecal valve maneuver and how is it related to treating SIBO?

iPet's Ally Q&A Round-up 02-01-21

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Hello! I’m Dr. Ruth Roberts, your pet’s ally. I hope that you are all well. Today we’re going to start off with a question that’s been plaguing the hell out of me for the last several weeks.

1. What is ileocecal valve maneuver and how is it related to treating SIBO?

This is all completely experimental since there is a lot of evidence on the human side but unfortunately, not much on the veterinary side because we still don’t understand it very well. Again, this is my attempt to draw some parallels between what’s been working for humans and bring them into what we might be able to do to help our dogs better.

One of the things that I found is something called ileocecal valve maneuver. First, what I want to do is explain what that means in terms of both human medicine and then how that might translate to veterinary medicine. So, if we look up ileocecal valve syndrome; on the human side there is a valve that goes between the ilium which is the last part of the small intestine, the cecum which is the first part of the large intestine, and the appendix. The idea is that when the valve is open and fails to close, the materials come from the large intestine up into the small intestine which can make those bacterial counts go sky high resulting to SIBO or Small Intestinal Bacterial Overgrowth.

The other way this can happen is when the valve is closed and fails to open, so things build up in the small intestine and can’t descend down into the large intestine. From that presentation, you’ll remember that SIBO happens when you have food poisoning. Your body develops antibodies to the enterotoxins which happens to be very close in structure into a protein called vinculin – the cells of Cajal. When that happens, the migrating motor complex no longer works because of the innervation of the migrating motor complex that tells it to do its thing.

When I started having difficulty with SIBO, I learned a lot. Ileocecal valve is a couple of inches towards the belly button, and if you have a gas that just isn’t working, it is a way to help get things going. So, if we are in a chronic state of panic, our innervation gets messed up specifically the sympathetic and parasympathetic network. Personally, I was able to do this maneuver and provide substantial relief for myself, so I’m thinking of how we can translate this to dogs.

Basically, dogs don’t have appendix but they have the cecum instead which is a much larger version of appendix. The appendix in humans is considered to be a vestigial organ of the cecum. In horses, this is an enormous organ because this where they do their fermentation. For cows and ungulates, it’s still in the same concept and the same structures. So, from the small intestine onto the large intestine, some of the material can go into the cecum and do what we’re not sure, to be honest.

Now, take note that when learning anatomy, the charts of the digestive system is not the way it looks when you actually open the belly up. In truth, the intestines are going to be all kind of jumbled up in there. For a frame of reference, the charts help a little except for that we’re missing about 10 or 12 feet of intestine in between the jejunum. We have the pylorus, a valve from the stomach up, the esophagus, another valve at the top and then down it comes into the duodenum and into the jejunum and off we go. Then, 10 or 12 feet later, we end up back at the ilium, cecum, and large intestine. I hope that makes a little more sense.

Now, in pets, it’s going to be in the lower right quadrant. I think what may be of assistance is if the dog is lying with its left side down because it is going to pop the cecum up and sometimes, you can actually feel gas bubbles. My supposition is that if we apply very gentle pressure to the abdomen of the dog kind of starting from the lumbar spine going down, we’re going to be over the top of the cecum. You have to do this really gently. Also, I can tell you that doing this myself was exquisitely painful. What I would do is with two hands, kind of one over the top of each other, gently compress over the stomach area. If your dog is turning around or getting up, you’re doing it too hard. Hold it and when you feel some resistance or if you feel a big gas bubble, or if your pup tells you that it is really uncomfortable, then back off a little bit. Oftentimes just holding that pressure will release a lot of spasm that was going on and all of the sudden the gut would start moving again.

The other thing is that there is often a motility issue associated with SIBO, meaning that whether it’s from migrating motor complex or whether it’s ileocecal valve syndrome or a myriad of other things, things aren’t moving downwards very well. For other types of food, the motility would stop in the lower bowel, and it’s really miserable. The problem is that your pets are actually absorbing enterotoxins because it’s all sitting there and fermenting, and the bad bugs get in control.

The other thing you can do too is to see if you can get a dilute ginger tea added to the food. What I would do is start making a fairly strong tea of ginger root dry or fresh and then add roughly a tablespoon per meal. The deal with ginger is it does help to improve gastric motility. The human dose for ginger is a thousand milligrams at bedtime and so if we parlay that back to a dog, for a small dog, something like 250 milligrams of ginger would be a good start. It is spicy so it can be difficult to get dogs to eat it. What you can also do is put a small amount of dried ginger powder into wrapped into a treat.

2. What can I use as a substitute for dog toothpaste?

What I would suggest doing is trying bentonite clay and a little bit of coconut oil or another type of oil that your pups can tolerate. Literally, just put some on your finger and brush it inside the mouth. The bentonite clay is not harmful if they swallow it. Additionally, dogs generally like the coconut oil. Hopefully, that will help you.

3. What can keep disseminated histiocytic sarcoma at bay or make it morph into cancer?

Suppose that your pup has had initial diagnosis different from the oncologist’s diagnosis which is disseminated histiocytic sarcoma, I would have to say that if there’s nothing visible in the spleen and liver, then there was a different diagnosis here. Assuming that your pup has had a lot of problems plus unfortunately, long – term inflammation does some weird stuff also.

Now, this is the thing; steroids are here for a reason. It’s horrible when you have to be on them for the rest of your life but when you need them, you need them. If this has provided comfort and your pup’s able to relax, I think that’s great. You can stop the CBD and the CBD with THC. I don’t think they’ll have that much effect on the liver. Furthermore, this is also a way for you to be clear about what is or not helping. Now, assuming you pup is on Denamarin, I would suggest adding in some regular milk thistle.

The other thing is that, I think it’s reasonable to stop the TCM herbs if you are using any, so then you can figure out what’s working. Also, if your pup is on so much stuff, that makes it hard to know what’s helping and not helping. This is an opportunity to kind of clear the decks, let the sledgehammer do its work, and then start adding thing back in one by one. They must earn their place back in your pup’s regimen.

4. How do dogs get vitamin D – 3 in their diets?

I believe dogs can actually make vitamin D-3. They don’t get it from the plants so they have to consume it. The frustrating part is that we don’t know what too little is but we know what too much is for dogs. This is the problem, many of the pet food recalls have been due to excess amount of vitamin D-3.

Generally, we have some clue about what the vitamin D dose should be. You can use a liquid type of vitamin D because it comes in a thousand IU per drop. Now, this is where you go very carefully because calcitriol which is a form of vitamin D-3 has been one of the big issues. The problem now is that we’re just starting to see what dogs do and don’t need for vitamin D so it’s another topic I need to revisit because I think finally, there is some research starting to come out about it.

5. What are the possible causes of soft and hard stool in dogs and how to treat them?

Suppose you pup is straining and is either having hard or soft stool. What I would suggest doing if the stools look flat or like a ribbon structure; if they’re not coming out normally, I would ask your veterinarian to take a look to make sure that your pup doesn’t have anal impactions, and make sure that there’s not something in the area of the rectum that’s creating a problem like a tumor or lymph nodes, and see if either of those things are going on. Make sure first that there is not a structural issue. Now, if your pup is bouncing between soft and hard stools, I am wondering if your pup has a motility issue. Again, your dog may be a candidate for trying this abdominal massage to see if we can get things moving from the ileocecal valve both forwards and backwards.

The other thing you can do if you know your pup goes out to pass a stool or vice versa, you can take an ice cube and kind of rub it around the edge of the rectum and that will often stimulate the colon to get rid of the stuff that’s in there. First, make sure it’s not a functional problem and then if it is not, then try the stimulation of the rectum and then also massaging the ileocecal valve.

6. Myths in food toxicity in your pets’ diet

Many folks have provided terrific amount of information over the years some of it are good but some of it is not so good. They’re going though things that sometimes are based in science and sometimes not. For instance, apples, bananas, berries, blueberries, cranberries, raspberry, strawberry, cucumbers, cantaloupe, oranges and other citrus fruits, are all the things that they say are okay and there is also a list of fruits that are bad. Actually, the problem is not in the fruit itself but it’s in the pit and so a small amount is okay.

Again, the thing is that all of these are dose dependent same thing with coconut oil. If we eat tons of it all the time, it can be a problem same thing with grapes and chocolates. If you feed a ton of it, it’s a massive problem but if you feed a little bit, it’s okay. I mean, we’ve all fed our dogs grapes for years but we don’t feed them a kilo at a whack. Many sites like to educate through fear so I think you have to take everything with a grain of salt. Anyways, too much coconut oil can be a massive problem as far as for dogs that are sensitive to coconut oil. Does that mean you should never use it? No, but you should limit it pretty markedly for dogs that have had issues with pancreatitis. I hope that is helpful.

That’s what I have for you today. Until next week. Give all your pets a big hug for me. Many thanks!